How Useful are the AMA Guidelines on Social Media and Physicians?

A few posts ago, I noted that the AMA had released guidelines regarding how physicians should use social media.  I noted that I would try to find the full guidelines and return to discuss in more detail.  I was surprised when I actually saw a copy of the new guidelines, mainly because the actual policy is not all that much more detailed than the initial summary.  In essence, the guidelines advise physicians to ensure both patients’ and physicians’ own privacy, maintain appropriate doctor-patient relationships and act accordingly to professional standards, to monitor and address on-line information posted by colleagues, and to remember that any information one posts on-line may have an impact on one’s professional career.

A few colleagues have already posted about the guidelines, and they had different perspectives.  Jane Sarasohn-Kahn of the Health Populi blog and Ted Eytan, MD both felt the guidelines were useful.  Health Populi notes the AMA’s late arrival in this area, but welcomes the early steps of promoting and guiding physician engagement with patients via SM.  Dr. Eytan highlights some issues with the guidelines but feels that they will be useful in promoting discussion and dialogue between physicians and patients regarding SM’s role in health care.  On the other hand, the ScienceRoll blog was unimpressed, pointing out how general the guidelines are and the lack of specific recommendations that might have been included.  That post’s author believes that these guidelines are nothing more than publicity on the AMA’s part, and that they do not provide any true value.

The #hcsm Twitter chat participants discussed the guidelines on November 14.  The overall tone of the discussion was one of being generally unimpressed that the guidelines would have any great impact, yet hopeful that the guidelines may help further discussion and debate.  No-one seemed to feel that the guidelines suggested any sort of turning point on SM use in health care.  The only new element introduced in the guidelines is the recommendation that physicians should police each other’s SM postings and take action if inappropriate posts were noted–either by discussing with the posting individual or by reporting the individual to the necessary authorities.  These element created more discussion than some of the others, but even here the guideline is so vague that its actual impact is difficult to assess.

My take on the guidelines are these:

• First, these guidelines don’t really make much of a difference in my use of SM.  Anyone who has been active in discussing SM use in health care or by health care providers has already seen these proposals and suggestions multiple times.  For anyone active in the #hcsm or the #MDChat Twitter conversations, these guidelines largely repeat ideas already discussed and conclusions already reached by many (most?) of those already using SM to promote health care communications.
• Second, these guidelines are not practical or concrete enough to provide protection for MDs using SM.  If a patient or a colleague complains about what I post on-line, I would be hard-pressed to point at the the AMA’s guidelines and prove that I have not done anything wrong.  These guidelines do not provide any sort of “safe harbor” criteria, which could provide cover for a physician who had used SM in the “right” way.  This lack of detail or of specific examples means that I cannot be entirely sure that my posts will meet (or fail) the AMA’s test of appropriate use.
• Third, the idea that physicians should “police” risks alienating physicians from using SM.  If I feel that part of my job is to keep an eye on my colleagues’ posts (and to take action if I feel they have posted something “that appears unprofessional”), I might be less interested in seeking to engage with other docs via SM.  The guideline’s lack of specificity is also worrisome in two specific ways: 1) How does one decide if a post “appears unprofessional”?  This standard is worthless to anyone trying to judge another person’s post.  If I post about my dinner, is that “unprofessional”?  If I criticize the AMA, is that “unprofessional”?  There is no final arbiter on this issue, so in theory any post could “appear unprofessional”.  2) If a physician notices a post that is later judged to appear unprofessional and that physician did not take action, could there be sanctions or other harms as a result?
• Fourth, I think these guidelines may have a role in beginning the SM discussion at a formal level.  As vague as they are, they present a framework which can then be further developed and fleshed-out by the AMA or by other organizations.  The more engaged we are in the process as physicians, patients, and advocates, the more useful the guidelines may become.

If these guidelines are looked upon as the final word, they are clearly insufficient and could lead physicians to avoid or reduce SM communication even as patients are turning to SM more and more.  If it stops here, the AMA may have harmed the process of physicians exploring and incorporating SM as a valuable way to communicate with patients and peers.  As they currently stand, the guidelines do not advance the idea of SM in health care communications in any way.

However, if the AMA reads posts such as this, speaks with physician members and patients, and revises the guidelines to make them more useful and more valuable (creating guidelines that could be used to establish “safe harbor” use of SM, and clarifying when/how physicians should address other people’s posts), then these guidelines could be seen as a first draft of useful and effective SM guidelines that could benefit physicians and patients alike.